Healthcare Provider Details

I. General information

NPI: 1346939121
Provider Name (Legal Business Name): LYNDSAY MCCLELLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MEETING ST
CHARLESTON SC
29401-3153
US

IV. Provider business mailing address

204 BASSWOOD AVE
SUMMERVILLE SC
29483-4473
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65468
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: